Abstract. Childhood obesity has become one of the most common health problems facing children in America. Results from the Third National Health and Nutrition Examination Survey reveal that ethnic minority children in the United States are at particular risk for development of cardiovascular disease due to their disproportionate levels of obesity. In treating childhood obesity among ethnic minorities, practitioners need to be mindful of the cultural norms surrounding body size.Additional concerns that must be addressed include the effects of target marketing of unhealthy foods toward ethnic minorities and environmental deterrents to outside physical activities, to name a few. Strategies given to address the problem of childhood obesity among ethnic minorities include, increasing the child’s physical activity, reducing television viewing and the adoption and maintenance of healthy lifestyle practices for the entire family.
Key Words: Childhood Obesity; Ethnic Minorities; Children; Overweight; Culture **********According to the Third National Health and Nutrition Examinations Survey (NHANES III), obesity is now an epidemic in the United States. An estimated 97 million adults in the US and one in five children between the ages of 6 and 17 is overweight. In the thirty years since NHANES I was conducted, the number of children in the United States who are overweight has more than doubled (Winkleby, Robinson, Sunquist, and Kramer, 1999; Strass & Knight, 1999).Once obesity develops, it is difficult to treat, and obese children are more likely to become obese adults (Power, Lake, & Cole, 1997; Serdula, Ivery, Coates, Freeman, Williamson, & Byers, 1993).
Obesity has been positively identified as a major determinant of adverse serum lipid and lipoproteins and blood pressure levels, eve...
n in children (Berensen, Srinivasan, Wattigney, and Hersha, 1993; Aristimuno, Foster, Vouis, Srinivasan, & Berensan 1984). According to Berensan, et al, because obesity begins in childhood, it is important to determine the level at which obesity begins to influence cardiovascular risk.In childhood, obesity is associated with high blood pressure levels, higher insulin levels, increased heart rate and cardiac output, and high level of very low-density lipoprotein cholesterol (HDL). These factors have all been observed to have a major impact on the future development of cardiovascular disease (Lauer, Bunts, Clark, & Mahoney, 1991; Webber, Osganian, Luepker, Feldman, Stone, Elder, Perry, Nader, Parcel, Broyles, & McKinlay, 1995; and Moussa, S. Kaik, Selwanes, Yaghy, & Bin-Othman, 1994, McMurray, Harrell, Levine, & Gansky, 1995).Cultural Variations in Obese Children Among African American and Mexican American girls, the early onset of obesity and high insulin levels may be precursors of the higher incidence of diabetes mellitus seen in these groups in adulthood (Berensen, et al, 1993, Alexander, Sherman, & Clark, 1991).
Culturally, attitudes toward obesity are found to be more lenient in African American communities (Kumanyika, Wilson, & Guilford-Davenport, 1993; Davis, Northington, & Kolar, 2000).Data from CATCH, the Child and Adolescent Trial for Cardiovascular Health, of the National Heart, Lung, and Blood Institute which sponsored multicenter school-based intervention programs, revealed several significant differences along cultural lines in the children. The CATCH population consisted of 3,530 Anglo-American children, 674 African-American children, and 708 Latino children, in the third grade in the states of California, Louisiana, Minnesota, and Texas. HDL cholesterol
levels were highest in African-American (55. 5 mg/dl) compared with 50. 7 mg/dl for Anglo Americans and 51.
3 mg/dl (p;0. 0001) for Latinos.Further, Latino children had the largest body mass index (p;0. 05); however, blood pressure levels were similar for boys and girls among the three races (Webber, et, al, 1995).
Similarly, findings from the Third National Health and Nutrition Examination, 1998-1999, study which included a total of 2,769 black, 2,854 Mexican American, and 2,063 white children and young adults ages 6 to 24 years revealed that the Body Mass Index (BMI) levels were significantly higher for black and Mexican American girls than for white girls; These differences were evident as early as ages 6 to 9 (a difference of approximately 0. BMI units) and widening thereafter (; 2 BMI units among 18 to 24 year olds). Regarding dietary intake from fat, intake was significantly higher for black than for white boys. Blood pressure levels were higher for black girls than for white girls in every age group, and glycosylated hemoglobin levels were highest for black and Mexican girls and boys in every age group (Winkleby, Robinson, Sundquist, & Kraemer, 1999).Clearly, the obese child is placed in a high-risk category for development of cardiovascular disease and diabetes.
Chu, Rimm, Wong, Liou, and Shieh (1998) evaluated the clustering of cardiovascular disease risk factors among 1,366 randomly selected junior high school (aged 13. 34) children in Taipei, Taiwan. Results of the study revealed that boys had a higher body mass index, systolic blood pressure, and glucose concentration than girls. However, girls had higher lipid and lipoprotein concentration than boys.
Following adjustment for age, obese boys had- a significantly higher B/P, ratio of total to HDL cholesterol, and glucose, cholesterol, triacyglycerol, HDL cholesterol, LDL cholesterol, and apoliprotein B concentrations than non-obese boys. For girls in the study, B/P, HDL cholesterol, LDL cholesterol, and ratio of total to HDL cholesterol were significantly different between non-obese and obese girls. Approximately 70% of the obese boys had one significant risk factor for CVD and 25% of the boys had two or more significant risk factors for CVD.Lastly Chu, et al found an association between obesity and higher B/P and between obesity and blood glucose and lipid concentrations for both sexes.
Fifth through eight graders (aged 10 to 14) in Minneapolis, Minnesota were surveyed in 1986 and again in 1996. In this multicultural study of 8,222 children in 1986 and 10,241 children in 1996, systolic blood pressure was significantly higher in 1996 than 1986 and diastolic pressure was lower in 1996 than 1986 in all ethnic and gender groups (African American, Hispanic, Native American, Asian, and non-Hispanic white groups).Additionally, weight and body mass indexes were significantly higher in all groups in 1996. Researchers submit that while there is no conclusive evidence to explain the drop in diastolic blood pressures of the group, possible explanations offered included treatment of hypertension, physical activity and decrease salt consumption in the adult population. What is evident from the study is that across ethnic lines, children are heavier as evidenced by their body mass indexes and that there is a corresponding increase
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